Thyroid and Afib

This is my first post to the site. I am a new member as of today.

Last year I was diagnosed with Afib for the first time. The culprit was my thyroid and having too many meds that caused me to become hyperthyroid (my TSH level was off the chart "low") even though I was being treated for years for hypothyroidism. Given I had been running for many years, I thought the sudden rise in my heart rate was due to the running and my age. I would never consider myself an elite runner (never even ran a full marathon). Still, here I am and having seen several cardiologists and EP's this past year, and upon the recommendation of the last EP I saw, I went from taking sotalol for 6 weeks and then onto metoprolol (25 mcgs, 2 times daily) for about 6 weeks. I am also taking xarelto. I am now weaning off the metoprolol as I discovered when I had my labs done last week, my A1c increased (I am not diabetic but genetically predisposed to higher blood glucose levels than most people). As a result, when researching metoprolol and its effect on blood glucose levels, I learned metoprolol can increase blood glucose levels. Any suggestions for weaning off metoprolol? After feeling like I was finally making some progress, I now feel like I just took a step back. I am sure many of you can relate.

The metoprolol did make a difference but apparently, there is no other drug that can be prescribed that does the same thing for Afib but does not interfere with blood glucose levels (?). If there is, does anyone know what else would work? I hope I stay in sinus rhythm through this process and do not convert back to Afib. Where does that leave me. Getting my thyroid to normalize has been an exhausting process. I found an endocrinologist to help, unlike my previous PA . All I can say is for anyone who takes thyroid medication, to be proactive with it. I thought I was when I went in for lab work several times a year to check on the levels while trusting the doctors who were monitoring it at the time.

I continue to exercise (not running) so I can monitor my heart rate, eat a very healthy plant-based diet, and do all of the things recommended for living a healthy lifestyle (stress management, sleep, limited alcohol). Still, here I am.
,
Any advice would be greatly appreciated.

Thank you.

Hi, welcome to the forum. Sorry you found the need to seek us out, but I have some good news. If you've only been on metoprolol for six weeks, the easy way to wean yourself off is to just stop taking it. You don't need to wean off. Just quit taking it tomorrow morning.

The other commonly used rate limiting drug is diltiazem, but it also can increase A1C. There are others, but what might work for you is way above my pay grade.

But it's important that I said they are rate limiting drugs. They're not antiarrhythmics; they don't prevent or stop afib; they only lower your heart rate. So the question is how often do you experience episodes of afib, how long do they last, and how high does your heart rate go without the drugs?

Ultimately, the biggest difference in your afib will be made by getting your thyroid under control. Thyroid issues are one of the top causes of afib.

Welcome to the forum.

Unless you are experiencing incipient or established metabolic syndrome, I wouldn't put too much stock on the A1C level. Metoprolol has been prescribed for donkeys' years, and it has a solid reputation for clipping the highest highs when your heart rate rises due to AF. It has been prescribed literally tens of millions of times...plus refills. Lots of them.

The medical community doesn't like seeing heart rates higher than about 100 for periods over about 24 hours. If you go to an ER with a rate near 130, say, and many of us present with considerably higher heart rates, they will want to get it reduced as soon as possible. The go-to is metoprolol.

My wife found out she was hypo-thyroid when she was about four months pregnant with our first child. She was so bad that she had no reflexes with the hammer tap, and the doctor couldn't believe she had conceived. Naturally, I attributed that little success to my exceptional ability, but...(cough..) I wisely kept it to myself. But, I relate this because she literally took years to get her dosage dialed-in, and even then it had to be reviewed every six months for several years. You aren't alone in your exasperation, unfortunately.

I hope you won't mind an observation: plant-based diets work for some people, but they aren't for everyone. It has been discovered in the past few years that plant oils with high concentrations of linoleic acid tend to cause the production of arachidonic acid in people, which is a precursor to inflammation. I couldn't possibly say this applies in your case, but IF....IF...you have chronic inflammation, and some of that has gotten into your myocites, your heart tissue, it might explain your current circumstances. Chronic inflammation seems to be the great bane of modern health care providers.

Hi, Casey:

Thank you for responding to my post. I felt a bit more at ease with your comments. Believe me, I simply did not know where to go with this current situation I am in. I do believe in hope. I have not had an Afib episode since I went on the sotalol and metoprolol, all very good. Just a reduction of my heart rate, which never really got as high as I see many people report. I never needed to go to the ER to get it under control. Again, I sincerely appreciate your comments. It was, for me, a breath of fresh air.

Thank you, gloaming, for taking the time to respond to my post. To read that I should not put too much stock into an elevated A1c level while taking a beta blocker such as Metoprolol left me with some relief, given your thoughts on the drug. I have an appointment with the endocrinologist for this week and will discuss her thoughts on whether I should go back on the drug. Honestly, I don't know if these doctors really care that much as they have limited time with the patient and have the belief that the current problem (going off Metoprolol) is not their expertise. Just leave it with the cardiologist to address. Where does that leave the patient who feels his or her needs are not being addressed. I heard functional medicine is the way to go where the patient is treated as a whole and not these subparts. And to hear that resolving my current thyroid problem could take a bit of time, well, guess that is all I have at the moment. I am taking 75 mcgs of Levothyroxine at the moment. Went down from 100 mcgs back in May when this whole thing started. It has been a slow downward process, all due to being in "hyperthyroid" for 2 years, of which should never have happened due to my initial diagnosis, by my then treating physician, years ago of hypothyroid. There is also a philosophy out there, the lower the TSH level for the patient the better. Unfortunately, that can have major implications on the heart, such as in my case.

Regarding plant-based, I should be more specific. I do eat chicken and fish and probably follow more of a Mediterranean diet overall. I appreciate your comments and concern. Perhaps I should have been more specific.

Thanks, again, for your encouragement. It made a difference for me going forward in the treatment of my condition.

I take it you're no longer taking sotalol since it would make no sense to combine it with metoprolol (could even be dangerous). Just so you know, sotalol is an antiarrhythmic. It's the only beta blocker that is. It's also a rate limiter like all the beta blockers.

You appear to have succumbed to AF due to a chronic hypothyroidy, but there is as much a chance of having problems with an over productive pituitary gland and hyperthyroidy. There's a wide-ish sweet spot between the two extremes for individuals, whatever those are, and however wide the sweet spot is. The problem is that the thyroid doesn't know it's in a ball game and won't play by the rules. So, getting you dialed in can take many months, and then a later assay will show you too low or too high yet again!

[www.verywellhealth.com]

Hi, Carey:
Yes. I am no longer taking sotalol. The EP switched me to metoprolol of which I am now discontinuing. Had I not discovered it would affect my blood glucose levels, I would probably still be on it. I was not scheduled to see the EP for another 6 months. I think like many people, the fewer the meds needing to be taken, the better. Obviously, if the idea is to improve one's quality of life, meds are required.

Thank you.

Yep. Agreed. My TSH level has gone up to a range of acceptability, per the labs just received this past week. Essentially, my pituitary gland was producing all of the TSH while I was stil l taking the drugs. My body was flooded with the stuff. Then Afib. So, now that has improved but, like a seesaw, my T3 level went down and is now out of the "acceptable range." It is a delicate balance and to try to figure out when my "body" feels "off", what is causing it since there doesn't seem to be a happy medium. I never considered joining a support group for people like me with thyroid problems. The Afib was my main concern. At some point, I would like to get off the anticoagulant but an EP (I have been to 3 so far), told me a woman over the age of 65 should be on anticoagulants for the rest of her life, regardless of an Afib diagnosis. I used to take a fish oil supplement before all of this. Interesting, though, the EP I am currently seeing, said at some point I could go off the Xarelto, if I don't have any episodes of Afib and can take a baby aspirin instead. But, I heard such a treatment, at one time widely recommended, is no longer supported. Yikes!

Thanks, again.

Diana:

You were hyper thyroid for quite a while, how is your thyroid level now. If you were hyper it should'nt take long to bring your thyroid down. Just stop taking your thyroid meds a couple of times a week. I know how you feel as I went hyper from taking too much thyroid and it put me into
'AF. You have to keep an eye on your levels, the problem is the doctors don't want to take your thyroid levels too often. Hyper thyroid or hypo can put you in AF

Diana, when I had my first ablation, and an angiogram before that to see if I had a blockage somewhere, I was to take a baby aspirin (enteric, low dose) once each day for a month afterwards. This was IN ADDITION to a resumption of my apixaban (Eliquis brand, much like your Xarelto). The two have different properties, aspirin and apixaban, and were complementary, according to the physician.

I think they have gone soft on aspirin as the go-to because they have learned more about thrombosis, its genesis, and its mechanisms. They have found that aspirin is not complete enough to prevent some kinds that are at least as harmful and potentially fatal. And if it helps, both my EP and my cardiologist have assured me that I should take apixaban until I expire. I look at it as a keep-out-of-jail-free card. Yeah it's a pain, yeah I would much rather not, and yeah there's an expense and a risk to the drug, but it really is cheap insurance against not drawing all that accrued pension.

><

Hi, Elizabeth:

Thank you for taking the time to respond to my post. I appreciate your comments about your own experiences. As I understood it, after I was diagnosed as having Afib, the role of the endocrinologist was to slowly bring up my TSH levels which included slowly weaning me down from all of the thyroid medication I was taking. My "TSH" level was practically "0." So, my pituitary gland, along with the meds, at the time, pre Afib diagnosis, was flooding my body with the hormone, and there I was, Afib. The biggest problem I encountered, was having to find an endocrinologist who could manage my thyroid back to recovery properly as opposed to the PA I trusted who in turn, she trusted the pharmacist who, in truth, was recommending to the PA, what my prescriptions for my thyroid should be. The PA had no clue and would up approving what the pharmacist recommended. In truth, this was an issue of negligence on the part of both people. And I was the guinea pig.

I am now on my way to recovery but it has taken 10 months. I don't wish this on anyone. It is a delicate balance of getting one's thyroid back to where it needs to be.

Good to know that hypothyroid can also lead to Afib. I guess I thought it was more an issue of being hyperthyroid. What, may I ask, did you do when you were told you had Afib? How did you manage it and what meds, aside from thyroid medication, did you have to take? Did you have to have any ablations to rid yourself of Afib? Do you continue to struggle with it? How has it impacted your life, overall?

Thank you, again.
Diana

Many thanks for your perspective on the aspirin v Xarelto discussion. There are side effects with taking Xarelto, aside from bleeding. It really is a blood thinner but noted as anticoagulant. One of the side effects, as I believe I read it on the label somewhere, it can cause macular degeneration. Perhaps in some cases, of course, but not all. And, I wonder the belief by some in the medical community, about women who are 65 and older, with or without heart disease, automatically being placed on an anticoagulant since women have a high risk of stroke.

I understand your point of view. Live your life to its fullest and do all you can to enjoy whatever it has to hold.

Quote
Diana
It really is a blood thinner but noted as anticoagulant.

Not sure what you mean by that. None of the drugs used to prevent clotting actually thin the blood. They just prevent clots from forming.

Diana said:


Good to know that hypothyroid can also lead to Afib. I guess I thought it was more an issue of being hyperthyroid. What, may I ask, did you do when you were told you had Afib? How did you manage it and what meds, aside from thyroid medication, did you have to take? Did you have to have any ablations to rid yourself of Afib? Do you continue to struggle with it? How has it impacted your life, overall?

Diana:
I had paraoxamal AF, for about 20 years, I got it only a few times a year when I first got AF and I always converted, I did take Propafenone. during a lot of that time. I did not take any blood thinner, I don't recommend this for others, just saying that is what I did. The last few years of my AF I started getting it more often, then about 3 years ago, I felt very hyper and my thyroid was again too much and I felt very nervous and hyper, I went into AF and this time I did not come out of it. So, I am now in permanent AF, but I don't feel it, my heart rate is normal, I feel pretty good, I do get tried if I do too much, but hey I am also near ninety. I never had an ablation, because I didn't get AF that often during my early years, there are pros and cons about an ablation, for me as I was getting older without too much problems with AF, I just went with it Some of these doctors want your TSH very low, a person feels good but it can lead to AF and I had a Holistic doctor. However, they do go more by your T4 and free T3 and mine was usually OK. I usually went by my TSH and that usually proved me right. The only meds I take now is my Thyroid med and zarelto. If we have thyroid problems watch it carefully, your T3 and free T4 should be within the limits and TSH should be over 1.0, that is where I didn't have any problems, only when the TSH was under 1.0, my doctor thought that was OK, I felt great but it gave me AF problems.. We are all different and I am not a big person.

Hi, Carey:

Often times, certain medical procedures require discontinuing the use of aspirin, blood thinners and anti inflammatory drugs Would an anti-coagulant be included to stop taking?

Thanks.

Hi, Elizabeth:

Wow! Almost 90. Congratulations.

I am thin and not overweight myself. Have always been that way, overall.

I appreciate the comments you made in response to my questions. I wonder if I will follow in your tracks, regarding Afib. I, too have, paroxysmal afib, or at least that is what it shows on my chart. I learned that one's T3 level can be affected when an individual is taking a beta blocker. The beta blocker, specifically, Metoprolol, causes free T4 levels from converting to free T3, so mine went down. To complicate matters, hyperthyroidism and the use of Metoprolol can increase one's blood sugar levels. For me, my A1c increased, all due to the Metoprolol (trying to regulate my heart rate but then causing a spike in my blood sugar level. Very frustrating. To add to it, this form of treatment for hyperthyroidism can lead to Type 2 Diabetes. I did ask the doctor for an alternative form of treatment aside from the Metoprolol and all they could say was an ablation. I feel that having an ablation seems to be their "go to word" as they don't want to work with a patient for something more suitable. There are beta blockers out there that do not increase blood sugar levels. Interesting your comment that your heart rate is "normal." Guess I thought Afib was an irregular heart rate. Now that you are "living" with it and doing okay, aside from getting tired which I get, you seem to be doing extremely well.

Quote
Diana
Often times, certain medical procedures require discontinuing the use of aspirin, blood thinners and anti inflammatory drugs Would an anti-coagulant be included to stop taking?

Yes.

"Blood thinners" and anticoagulants are the same thing. There are no drugs I know of that actually thin the blood. "Blood thinner" is a term doctors have long used as a simplification for the actual name "anticoagulant" just to keep it simple for patients. None of the drugs you know as blood thinners such as warfarin, Eliquis, Xarelto, etc. actually thin the blood. They are all anticoagulants.

So if you're undergoing a procedure where the doc says stop all blood thinners, they mean stop Eliquis, Xarelto, warfarin, aspirin, etc.

Thank you, Carey, for clarifying that for me. In thinking about both my parents, who are no deceased, they were on anticoagulants but at the time, referred to as blood thinners. Then there is the other one I hear which is don't take anti-inflammatory medications, as well, prior to a procedure. You obviously know a lot about the subject of Afib. I appreciate your moderating this site. I am sure you put in countless hours in doing so.

Thanks, again.